Cardiac involvement of HMOD may persist subclinically for long periods of time: (i) atrial fibrillation (AF), (ii) left atrial (LA) and left ventricular (LV) dilatation, (iii) impaired LV systolic and diastolic function and heart failure (HF), (iv) LV hypertrophy, (v) obstructive and non-obstructive coronary artery disease (CAD), (vi) myocardial infarction, and (vii) increased cardiac biomarkers hs-cTn and NT-proBNP [1,2,3]. Here, NPPB is linked to atrial fibrillation.